Ø Gold standard for breast imaging Ø Used as a diagnostic for symptomatic patients or as a screening tool for asymptomatic women ages 40 and over Ø The goal is early detection of breast cancer Ø Proven to reduce mortality rate from breast cancer Ø Uses low dose ionizing radiation to create images Ø It can detect tumors long before they can be palpated
Brest lesion seen on Mammogram
Magnetic Resonance Imaging of the Breast (MRI)
Ø Noninvasive test that uses a powerful magnetic field, radiofrequency pulses and a computer to acquire images Ø Provides good contrast between soft tissues and evaluation of dense breasts Ø Used as follow up to other breast imaging modalities Ø Used to stage the extent of breast cancer Ø May be used as a screening tool for women with very high risk of developing breast cancer Disadvantages · Increased cost · Increased exam time · Differentiation between benign and malignant tumors
MRI scan of the breast
breast scintimammogram
Scintimammography- Nuclear Medicine Test
Ø Used to detect cancer cells in the patients with abnormal mammograms Ø Not used for screening or in the place of a mammogram Ø Uses a small amount of a radioactive substance called technetium 99, a tracer injected into the patients vein, which is then taken up by cancer cells Ø Improved evaluation of dense breasts and lesions difficult to identify with mammography Ø Radiation is a great diadvantage
Ultrasound
Typically used for further evaluation of masses found on mammography or for palpable masses
Allows us to obtain images in almost any orientation
Especially usefull in patients with dense breasts.( common in younger women)
Masses in patients with dense breasts are difficult to detect on mammograms
Guided interventional procedures of the breast
Used as screening tool for women ages 30 and under that have a high risk for developing breast canner or for in patients presenting with: § palpable breast lump § dense breasts § pregnant or lactating patients § breast augmentation
Innovation in Breast Ultrasound Imaging
Automated Breast Volume Scanner - ABVS –Ultrasound System o Acquires full volume images of the breast o Offers a more comprehensive representation of the global anatomy of the breast o Ideal for dense breasts o Can distinguish between fatty and dense tissue o Diagnostic confidence is significantly increased o Allows us to aquire coronal view images ( view from nipple line to the breast wall) o Improved comfort and significantly reduced examination time
Elastography
v New and invaluable screening tool v Real time scanning technique v Looks at the mechanical properties of tissue v Determines the stiffness of the tissue by measuring the degree of distortion un external force application v Provides further insight into potential pathology v Has a good sensitivity for distinguishing benign vs. malignant lesion v Reproducible, more accurate diagnosis v Provides better care and management of the patient
Breast lesions appearance with Elastography vs.B Mode Stiff Masses( tissue) =Anechoic Non-stiff(soft) tissue= Echogenic
CYSTS
Cyst- Elastography
Simple Cyst-B Mode
Appearance Target Sign lesion Posterior enhancement Cyst looks smaller that what it looks like on B Mode US
Benign Lesions- Fibroadenoma Appearance Benign lesion usually look similar or smaller than on B-Mode Images
Suspicious (Malignant Lesions) Malignant Lesions -Appearance Larger than on B- Mode due to Desmoplastic reactiona around the mass. On B Mode this reaction appears as normal tissue but at a microscopic level this tissue is in fact stiffer.
Mammography
Ø Gold standard for breast imaging
Ø Used as a diagnostic for symptomatic patients or as a screening tool for asymptomatic women ages 40 and over
Ø The goal is early detection of breast cancer
Ø Proven to reduce mortality rate from breast cancer
Ø Uses low dose ionizing radiation to create images
Ø It can detect tumors long before they can be palpated
Magnetic Resonance Imaging of the Breast (MRI)
Ø Noninvasive test that uses a powerful magnetic field, radiofrequency pulses and a computer to acquire images
Ø Provides good contrast between soft tissues and evaluation of dense breasts
Ø Used as follow up to other breast imaging modalities
Ø Used to stage the extent of breast cancer
Ø May be used as a screening tool for women with very high risk of developing breast cancer
Disadvantages
· Increased cost
· Increased exam time
· Differentiation between benign and malignant tumors
Scintimammography- Nuclear Medicine Test
Ø Used to detect cancer cells in the patients with abnormal mammograms
Ø Not used for screening or in the place of a mammogram
Ø Uses a small amount of a radioactive substance called technetium 99, a tracer injected into the patients vein, which is then taken up by cancer cells
Ø Improved evaluation of dense breasts and lesions difficult to identify with mammography
Ø Radiation is a great diadvantage
Ultrasound
Used as screening tool for women ages 30 and under that have a high risk for developing breast canner or for in patients presenting with:
§ palpable breast lump
§ dense breasts
§ pregnant or lactating patients
§ breast augmentation
Innovation in Breast Ultrasound Imaging
Automated Breast Volume Scanner - ABVS –Ultrasound System
o Acquires full volume images of the breast
o Offers a more comprehensive representation of the global anatomy of the breast
o Ideal for dense breasts
o Can distinguish between fatty and dense tissue
o Diagnostic confidence is significantly increased
o Allows us to aquire coronal view images ( view from nipple line to the breast wall)
o Improved comfort and significantly reduced examination time
Elastography
v New and invaluable screening tool
v Real time scanning technique
v Looks at the mechanical properties of tissue
v Determines the stiffness of the tissue by measuring the degree of distortion un external force application
v Provides further insight into potential pathology
v Has a good sensitivity for distinguishing benign vs. malignant lesion
v Reproducible, more accurate diagnosis
v Provides better care and management of the patient
Breast lesions appearance with Elastography vs.B Mode
Stiff Masses( tissue) =Anechoic
Non-stiff(soft) tissue= Echogenic
CYSTS
Appearance
Target Sign lesion
Posterior enhancement
Cyst looks smaller that what it looks like on B Mode US
Benign Lesions- Fibroadenoma
Appearance
Benign lesion usually look similar or smaller than on B-Mode Images
Suspicious (Malignant Lesions)
Malignant Lesions -Appearance
Larger than on B- Mode due to Desmoplastic reactiona around the mass.
On B Mode this reaction appears as normal tissue but at a microscopic level this tissue is in fact stiffer.
http://www.youtube.com/watch?v=uulyRhtkzmc&feature=related